Author + information
- Serge C. Harb,
- Yuping Wu,
- Leslie Cho,
- Carol Rouphael,
- Paul Cremer,
- Venu Menon and
- Wael Jaber
Background: Pharmacologic (pharm) stress testing is typically performed when a patient (pt.) is unable to exercise (ex.). We sought to determine the prognostic implication of the inability to ex., reflected by pharm. testing referral, on survival.
Methods: All pts who underwent stress testing (ex. ECG, stress echo and nuclear) at our institution, between Jan. 1991 and Feb. 2015. Survival at 10 years was determined using the Social Security Death Index (SSDI) and institutional death status. Uni- and multi-variate Cox regression models and Kaplan Meier (KM) survival analysis were used to determine the impact of stress testing modality (pharm. vs. ex.) on survival.
Results: A total of 165,184 pts were included, among whom 23.5% underwent pharm. testing. Mean age was 55.8±12.9 years and 58% were male. At 10 years, 31% of those referred for pharm. testing died, compared to 8% in the ex. group. On univariate analysis, referral for pharm. testing conferred more than a five-fold increased risk of death [HR 5.22 (5.09-5.36), p<0.001]. Figure 1 shows the KM survival curve by modality of stress testing. After adjusting for cardiac risk factors (table in figure 1) and medication use, pharm. testing was the second most important risk factor for death (after age >65) with an adjusted HR of 2.82 (2.73-2.91), p <0.001.
Conclusions: Except for increasing age, referral for pharm. testing, as a reflection of the inability to exercise, is the most important predictor of short and long-term mortality in pts referred for stress testing.
Moderated Poster Contributions
Prevention Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 10:00 a.m.-10:10 a.m.
Session Title: Physical Activity and Prevention of Cardiometabolic Disease: Exercise Is Medicine
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1210M-05
- 2017 American College of Cardiology Foundation